Governor Gary Herbert wants Medicaid expansion in place by January

SALT LAKE CITY — Utah's governor said Friday he hopes to hand Utah legislators an alternative Medicaid expansion plan by fall and have the state's expansion in place by January.

Gov. Gary Herbert's comments came after meeting with new Secretary of Health and Human Services Sylvia Burwell, whom he said was informed and supportive of his Healthy Utah alternative to President Barack Obama's Medicaid expansion plan.

She has "a new set of eyes and ears and a desire to get something accomplished," he said, noting a few hurdles are left to clear before the federal government signs off on the plan to bring more coverage to Utahns. That includes a requirement for recipients to work or be looking for work to qualify, Herbert said.

"We think it's a principle that the recipients ought to have some skin in the game proportionate to their ability to pay," Herbert said, comparing the work provision to the state's food stamp program, Temporary Assistance for Needy Families and Supplemental Nutrition Assistance Program.

"We have models out there that work. We just need to see if they can be incorporated into the Affordable Care Act and this Medicaid expansion alternative."

He said he hopes to have approval for that in 30 days.

Medicaid expansion is part of Obama's Affordable Care Act that went into effect in January. So far 26 states have implemented Obama's program. Utah is one of 24 states that have yet to approve an expansion and one of three states currently debating Medicaid expansion. The state's sluggishness in securing the $258 million available for Medicaid expansion has drawn criticism from some who say there is a pressing need to help the uninsured.

At stake is coverage for approximately 110,000 low-income Utahns as well as the possibility of services cut for substance abuse prevention and treatment programs.

“We’re obviously very anxious to get this done in a timely fashion, but we’ll do it as quick as we can and we’ve got to make sure that the Legislature understands, that all their questions have been asked and answered and then we’ll move ahead,” Herbert said.

For some, that may not be soon enough.

Salt Lake County behavioral health services has seen a surge in those requesting treatment since the onset of the Affordable Care Act. The county is required by law to match 20 percent of legislative appropriations and has overmatched almost to the dollar, but the funds it puts forth are still not meeting the demand.

"We don't have the money anymore to do this," said Patrick Fleming, director of substance abuse at Salt Lake County behavioral health services.

In January, the county will cut 12 percent, or a total of $1.5 million, from 32 agencies such as Valley Mental Health, Odyssey House and the Boys and Girls Clubs, which provide treatment, counseling and other services for at risk populations, county officials said this week.

The cuts would impact 3,200 people, including 570 clients who receive treatment. The county was banking on the passage of the Healthy Utah plan to fill in the funding gap created by the cuts. If the expansion is not already in place, there may be a gap in services for those in need.

“That’s why we were so keen on the governor’s plan," Fleming said. "It really allows families to be on one plan. It requires a work element. It requires a co-pay. But more important than anything else, it keeps Utah tax dollars here in Utah. It keeps Salt Lake County tax dollars here in Salt Lake County,” he said.

It is estimated that taxpayers in Utah are paying up to $700 million for the Affordable Care Act. Those in the state will not see any return on this payment until some form of Medicaid expansion is approved.

In April, a BYU poll showed that most Utah voters support Medicaid expansion, with 43 percent behind Herbert's plan and 33 percent for the original plan under the care act, also known as Obamacare.

In addition to this, several community groups in Utah, including public policy consulting group Notalys and Utah Health Policy Project, will release results from a public opinion poll Tuesday that shows majority public support for Herbert's plan.

"When the majority of Utahns say we need to do something, we need to do something," said Rep. Rebecca Chavez-Houck, D-Salt Lake City.

She is part of the Utah Health Reform Task Force, consisting of 11 legislators and three support staff members. In May, Utah Department of Health Director David Patton told members that he expected to have a resolution in place by the end of summer.

Chavez-Houck said she s concerned about any potential delays, including a possibility of what she calls "deal breakers" if any aspect of the Healthy Utah plan is not approved.

"We don't want coverage to be delayed any longer than necessary because for us the ultimate goal is getting people covered and getting people well," she said.

Republican members of the committee and Republican House and Senate leadership were not immediately available for comment Friday. In late May, the Legislature's GOP majority said it would not want to address Medicaid expansion in what may be a one-day special session but would prefer to wait until the Legislature begins at the end of January.